BONE MARROW OEDEMA AND ITS RELATION TO PROGRESSION OF KNEE OSTEOARTHRITIS

Background:
 Lesions on bone scan which correspond to bone marrow edema lesions seen on magnetic resonance imaging (MRI) may increase the risk for radiographic deterioration in knee osteoarthritis.

Research question/s:
 Do oedema lesions in the sub-articular bone in patients with knee osteoarthritis increase the risk for radiographic progression and are the lesions associated with limb malalignment?

Methodology:
 Subjects: 233 subjects (> 45 yrs) with symptomatic knee osteoarthritis.

Experimental procedure: Subjects underwent baseline assessments including MRI of the knee and fluoroscopically positioned radiography. Repeated radiography (at 15 months) with long-limb films was obtained to assess mechanical alignment (varus, valgus). During follow up at 15 and 30 months, progression (defined as an increase over follow-up in medial or lateral joint space narrowing) was measured.

Measures of outcome: Relation of medial bone marrow oedema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment.

Main finding/s:
 Progression: 36% of knees with medial lesions showed medial progression compared with 8.1% of knees without lesions (OR for progression, 6.5 [95% CI, 3.0–14.0]): 26% of knees with lateral lesions showed lateral progression compared with 5.5% of knees without lesions (8.1%) (OR for progression, 6.1 [95% CI, 2.2–16.5]).

Conclusion/s:
 The presence of bone marrow oedema on MRI is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.

ARTHROSCOPIC TREATMENT OF OSTEOCHONDRAL LESIONS OF THE TALUS

Background:
 Non-operative treatment or excision alone of osteochondral lesions of the talus give poor results, but it appears that both excision, curettage …